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Updated: Jun 9, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Fungal Shoulder Periprosthetic Infections: A Systematic Review
Vasileios Giovanoulis1, Vasileios Pastamentzas2, Enejd Veizi3
1Department of Orthopaedic Surgery, Hôpital Henri Mondor, AP-HP, Université Paris Est Créteil (UPEC), 94010 Creteil, France.
Abstract:
Background: Data regarding fungal PJIs of the shoulder are scarce. The present systematic review aims to identify and evaluate all published shoulder fungal PJIs in an effort to better understand the diagnostic and therapeutic approach to these infections. Methods: A systematic review according to the PRISMA guidelines was conducted, locating all shoulder fungal PJIs. The initial search located 1435 articles. Data were collected on demographics, the causative fungus, antifungal treatment (AFT), surgical interventions, and infection outcomes. Results: After screening and implementation of the inclusion criteria, a total of 10 articles, including 10 cases, were eligible. The sample's mean age was 62.44 years. Diabetes mellitus was the most common comorbidity (30%), while 70% were immunocompromised. Candida spp. was the most common causative fungus (nine cases; 90%), while all cases were confirmed with cultures. In three cases (30%), there was bacterial co-infection. The mean duration of antifungal treatment (AFT) was 8.4 weeks, while the preferred agent was fluconazole (60% of cases), followed by amphotericin B (30%). Most cases (50%) underwent resection arthroplasty as part of the treatment, while two-stage revision arthroplasty was performed in 30%. Infection's eradication was reported in 90% of the studied cases. Conclusions: The diagnosis and management of fungal periprosthetic shoulder infections are particularly challenging and require a multidisciplinary approach. The combination of antifungal therapy and tailored surgical strategies is crucial, but further research is needed to refine treatment protocols and address the unique considerations in shoulder PJIs.
Insights
Fungal periprosthetic joint infections (PJIs) of the shoulder are rare but challenging. Effective management requires a multidisciplinary approach combining antifungal therapy and surgical strategies for successful infection eradication.
Area of Science:
- Orthopedics
- Infectious Diseases
- Mycology
Background:
- Fungal periprosthetic joint infections (PJIs) of the shoulder are infrequently documented.
- Existing literature lacks comprehensive data on the diagnosis and treatment of these specific infections.
Purpose of the Study:
- To systematically review and evaluate all published cases of shoulder fungal PJIs.
- To enhance understanding of diagnostic and therapeutic strategies for shoulder fungal PJIs.
Main Methods:
- A systematic review adhering to PRISMA guidelines was performed.
- 1435 articles were initially screened, resulting in 10 eligible articles (10 cases).
- Data collected included demographics, causative fungi, antifungal treatment, surgical interventions, and outcomes.
Main Results:
- The mean patient age was 62.44 years, with 70% immunocompromised and 30% having diabetes mellitus.
- Candida spp. was the predominant pathogen (90%), often requiring a mean of 8.4 weeks of antifungal treatment (fluconazole preferred).
- Surgical interventions included resection arthroplasty (50%) and two-stage revision arthroplasty (30%), achieving 90% infection eradication.
Conclusions:
- Diagnosing and managing shoulder fungal PJIs is complex, necessitating a multidisciplinary team.
- A combination of antifungal therapy and specific surgical interventions is critical for successful treatment.
- Further research is required to optimize treatment protocols for shoulder fungal PJIs.
